Clostridioides difficile colonization amplification despite limited in-hospital transmission: A modeling study
Daniel De-la-Rosa-Martinez1, Travis C Porco1,2, Ashley Hazel1
1Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America.
Plos Medicine
|April 13, 2026
Summary
Hospitalization amplifies Clostridioides difficile colonization, potentially increasing community spread. Interventions targeting asymptomatic carriers are crucial for reducing the overall burden of this infection.
Area of Science:
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
- Microbial Transmission Dynamics
Background:
- Clostridioides difficile is a significant public health concern, with both healthcare-associated and community-onset infections contributing to the overall disease burden.
- The interplay between hospital settings and community colonization for C. difficile is not fully understood.
- Understanding transmission dynamics is key to controlling the spread of C. difficile.
Purpose of the Study:
- To quantify in-hospital transmission of C. difficile.
- To assess the hospital's contribution to community colonization.
- To evaluate interventions for asymptomatic carriers to reduce disease burden.
Main Methods:
- Development of a compartmental model to simulate C. difficile transmission dynamics.
- Estimation of the intrinsic reproduction number (Ri) and colonization amplification index (Ai).
- Sensitivity analyses were performed, and the impact of redefining healthcare-associated C. difficile infection (CDI) thresholds was evaluated. Interventions targeting asymptomatic carriers were simulated.
Main Results:
- The median intrinsic reproduction number (Ri) was 0.61, indicating limited sustained in-hospital transmission.
- The colonization amplification index (Ai) was 1.9, suggesting substantial amplification of colonization during hospitalization.
- Interventions targeting asymptomatic carriers, particularly combined contact precautions and prophylactic treatment, significantly reduced Ai and CDI incidence.
Conclusions:
- In-hospital transmission of C. difficile is generally limited, often sustained by community importation.
- Hospitalization amplifies C. difficile colonization, potentially contributing to community transmission.
- Interventions focused on asymptomatic carriers at admission and discharge are essential for mitigating C. difficile spread and reducing the overall burden.
More Related Videos
Related Concept Videos
01:25Colonisation of Pathogens
59
Pathogen colonization of host tissues is a critical step in the development of infectious diseases. Various pathogenic microorganisms, including bacteria, fungi, viruses, and protozoa, have evolved complex strategies to attach to, invade, and persist within host environments. These mechanisms enable pathogens to establish infections, evade immune responses, and resist antimicrobial treatments.Attachment to Host CellsIn bacteria, colonization typically begins with adherence to host epithelial...
59
01:25Transmission-based Precautions II: Airborne and Protective Environment
2.2K
Transmission-based precautions are for patients infected or suspected to be infected (or colonized) with organisms posing a significant risk to others. The transmission precautions include airborne and protective environment precautions.
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
2.2K
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
5.1K
Transmission-based precautions are for patients known to be infected or suspected to be infected or colonized with organisms that pose a significant risk to others. Some transmission-based precautions include contact, enteric, and droplet.
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
5.1K
01:20Infection
14.7K
When a pathogen enters the body and reproduces, it can cause an infection, damage body cells, and cause illness symptoms that eventually lead to disease. Therefore, its prevention requires breaking the chain of infection.
The chain begins with pathogens: bacteria, viruses, fungi, prions, or parasites such as protozoa helminths. These can be present on the skin as transient or resident flora, or they can be acquired from the environment. Identifying and treating the type of infection and...
The chain begins with pathogens: bacteria, viruses, fungi, prions, or parasites such as protozoa helminths. These can be present on the skin as transient or resident flora, or they can be acquired from the environment. Identifying and treating the type of infection and...
14.7K
01:27Confounding in Epidemiological Studies
1.1K
Confounding in statistical epidemiology represents a pivotal challenge, referring to the distortion in the perceived relationship between an exposure and an outcome due to the presence of a third variable, known as a confounder. This variable is associated with both the exposure and the outcome but is not a direct link in their causal chain. Its presence can lead to erroneous interpretations of the exposure's effect, either exaggerating or underestimating the true association. This...
1.1K
01:29Pneumonia II: Pathophysiology
4.4K
The pathophysiology of pneumonia involves the following steps:
4.4K